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SOUTH BURLINGTON – When Gov. Peter Shumlin signed physician-assisted suicide into law in 2013, he had no idea a member of a family he has known most of his life would be one of the first Vermonters to use the option.

Shumlin knew Maggie Lake of Putney had been battling cancer for several years. When Lake died, the governor left a message to convey his condolences to her adult kids, Hayden and Norah.

"I got this text back from Hayden," Shumlin recalled. "He just said: 'Thank you so much for your support. She was an irreplaceable mother. She will be deeply missed.'"

Then, Hayden Lake added: "I also want to thank you deeply for Vermont's death with dignity law. It allowed my mother to leave the world without prolonged pain and suffering."

"I had no idea at that point that Maggie had used Vermont's death with dignity law," Shumlin said.

The governor made the comments Wednesday during a bill-signing ceremony at South Burlington's Healthy Living Market. Maggie Lake's sister, Katy Lesser, owns the market.

When Act 39 passed in 2013, certain provisions, such as a mandatory waiting period, were scheduled to sunset July 1, 2016, as a compromise with detractors.

The Legislature acted last month to make the provisions permanent with passage of S. 108.

Vermont Patient Choice and Control at End of Life Act protects physicians from prosecution when they prescribe life-ending drugs to terminally-ill patients who have asked for the prescription and have a prognosis of death in six months or less. Oregon legalized the practice in 1998. Washington and Vermont has since followed suit. Vermont is the only state to pass the law legislatively.

The governor signed the bill Wednesday with Lesser and several lawmakers by his side.

"I'm really proud of the Legislature working together to frankly make this bill permanent," Shumlin said." I know this has been a difficult conversation for Vermont. It's been a smart conversation for Vermont, and it's written in a way that allows folks like Maggie Lake, who loved life so much, who wanted to live every second that she could a productive life, allowed her to face her terminal illness with the same dignity she carried throughout her entire life."

After Shumlin signed the bill, he gave the pen to Lesser as a keepsake.

"I'm honored to support the bill," Lesser said. "It's sort of a tribute to my sister. She believed in it strongly enough to use it."

Opponents of physician-assisted suicide tried to repeal the law through amendment on the House floor in April but fell short of enough votes.

Critics say the law opens the way for pressuring patients into ending their lives and could lead to euthanizing people who are elderly or have disabilities.

"It is well known that the most expensive health care is end-of-life care," said Guy Page, advocacy director with Vermont Alliance for Ethical Health Care. "It doesn't take a health care economist to see the shortest distance in finding ways to reduce health care costs is physician-assisted suicide."

Page said the alliance, made up mostly of physicians, would continue to advocate for repeal.

Maggie Lake, a nurse practitioner, wanted to end her life on her terms and pursued the option to its end, Lesser said. There was no outside pressure, Lesser said.

"I don't think there is any validity to that argument, with all of the safeguards put in place and the hurdles you have to jump over to get where you want to go," Lesser said of Page's statement. "I don't see how it could be abused."

To start the process, a patient makes two oral requests for a lethal prescription 15 days apart. Two doctors are required to affirm the patient's terminal diagnosis and a six-month prognosis.

The patient also is required to make a written request in the presence of two witnesses who are uninterested parties.

The patient must be able to self-administer the medication.

Physicians must wait 48 hours after all requirements before writing a prescription.

Lake was diagnosed with non-Hodgkins mantle cell lymphoma 10 years ago. At first, she responded well to treatment, including a stem cell transplant and chemotherapy. For six years, she led a healthy, active life, pursuing her passions of art and gardening, Lesser said. Then, the cancer came back. Doctors again gave Lake a stem cell transplant, this time with less success.

"Little by little, she lost everything that was dear to her," Lesser said. "She couldn't breathe, she couldn't think, she couldn't work. She was in constant pain, and she was told by her oncology team there was nothing more they could do."

Lesser said Lake had been talking about physician-assisted suicide for years before the practice was legalized.

"But she couldn't do anything about it until 2013," Lesser said.

Lake took the lethal prescription in January while at home with her family.

"That was exactly the way she wanted to die," Lesser said.

The experience of Maggie Lake's family "tells the story of why we all worked so hard on this bill," Shumlin said.